There are two types of myocardial revascularization: transmyocardial revascularization (TMR) and the less invasive percutaneous myocardial revascularization (PMR).

Both use high-energy lasers to create holes in the heart between the epicardium (outer layer) and the endocardium (inner layer) to allow blood to flow directly from the left ventricle into the myocardium (middle, muscular layer).

UT Southwestern also offers a dedicated
Cardiac Rehabilitation
Program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.

What to Expect

Myocardial Revascularization Preoperative Details

The surgeon provides specific instructions to the patient before the myocardial revascularization procedure, including risks such as bleeding, infection, or adverse reaction to anesthesia.

Patients also meet with the anesthesiologist prior to the surgery to review their medical history. Patients should not eat after midnight the night before the surgery.

On the day of surgery, the patient arrives at the hospital, registers, and changes into a hospital gown. A nurse reviews the patient’s charts to make sure there are no problems.

The anesthesiologist then starts an IV, and the patient is taken to the operating room, where the surgeon verifies the patient’s name and procedure before any medication is given. Surgery will begin once the patient is under anesthesia.

Myocardial Revascularization Operative Details

Transmyocardial Revascularization (TMR)

The surgeon makes an incision between the ribs and then spreads the ribs along one side to allow access to the heart. The patient does not need to be on a cardiopulmonary bypass machine because the procedure can be done with the heart still beating.

A high-energy laser beam is then applied to the left ventricle area and penetrates the layers of the heart muscle from the outside in to allow oxygenated blood to come directly out of the left ventricle to the myocardium, doing the work of the obstructed coronary artery. The surgeon uses stitches to close the initial incision.

Percutaneous Myocardial Revascularization (PMR)

The surgeon injects local anesthetic into an area on the groin and then makes a tiny incision to place a catheter (thin tube) in the femoral artery. A fiber-optic catheter is then placed inside the first catheter and guided through the blood vessels to the heart.

A high-energy laser beam is then emitted from the catheter through the endocardium of the left ventricle to the myocardium. In other words, the laser creates a hole through two layers of heart muscle from inside out. Once PMR is completed, the catheters are removed and the incision closed.

Myocardial Revascularization Postoperative Details

After surgery, patients are taken to the intensive care unit and monitored. Pain is likely, and pain medication is given as appropriate. Patients also might be on a respirator for up to a day after the surgery.

The length of the hospital stay depends on how quickly the patient is able to recover and perform some physical activity.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials can receive treatments years before they are available to the public.

Related Conditions and Treatments

Search for opportunities to participate in a heart or vascular research study.

Julia Körner

Julia Körner is an award-winning designer working at the convergence of architecture, product and fashion design - specialised in additive manufacturing and robotic technology. Her work stands out, recognised at the top level of these disciplines, where it has been featured internationally in world-renown museums, institutions and publications. She is founder and director of JK Design GmbH. Her recent collaborations involved 3D-Printed fashion pieces developed with Haute Couture Houses for Paris Fashion weeks and Hollywood Entertainment Productions. Julia is a graduate of the Architectural Association, London and University of Applied Arts, Vienna; she is a faculty member at the University of California, Los Angeles.

Achim Menges

Professor Achim Menges AA Dipl.(Hons.) RIBA II, Architect BDA, AKH Professor Achim Menges, born 1975, is a registered architect and professor at the University of Stuttgart, where he is the founding director of the Institute for Computational Design and Construction since 2008. He also is Visiting Professor in Architecture at Harvard University’s Graduate School of Design since 2009. Achim Menges practice and research focuses on the development of integral design processes at the intersection of morphogenetic design computation, biomimetic engineering and computer aided manufacturing that enables a highly articulated, performative built environment. His work is based on an interdisciplinary approach in collaboration with structural engineers, computer scientists, material scientists and biologists. Achim Menges has published several books on this work and related fields of design research, and he is the author/coauthor of numerous articles and scientific papers. His projects and design research has received many international awards, has been published and exhibited worldwide, and form parts of several renowned museum collections, among others, the permanent collection of the Centre Pompidou in Paris. Achim Menges is a member of several international research evaluation boards and a member of numerous scientific committees of leading peer-reviewed international journals and conferences.

Silvia Olp

Silvia Olp is the vice management of the aed, e.V., aed Society for Advancement of Architecture, Engineering, Design Stuttgart. She initiated the aed neuland, which is an award for young designer and she is head of communication for Phoenix Design Stuttgart/Munich. Her interest regarding technology and design is the aim to popularize it. Newcomers are close to her heart.

Are you ready for some scary numbers? After months of Mark Zuckerberg talking about how “Protecting our community is more important than maximizing our profits,”
Facebook
is preparing to turn that commitment into a Time Well Spent product.

Buried in Facebook’s Android app is an unreleased “Your Time on Facebook” feature. It shows the tally of how much time you spent on the Facebook app on your phone on each of the last seven days, and your average time spent per day. It lets you set a daily reminder that alerts you when you’ve reached your self-imposed limit, plus a shortcut to change your Facebook notification settings.

Facebook confirmed the feature development to TechCrunch, with a spokesperson telling us, “We’re always working on new ways to help make sure people’s time on Facebook is time well spent.”

The feature could help Facebook users stay mindful of how long they’re staring at the social network. This self-policing could be important since both and
Android
are launching their own screen time monitoring dashboards that reveal which apps are dominating your attention and can alert you or lock you out of apps when you hit your time limit. When Apple demoed the feature at WWDC, it used Facebook as an example of an app you might use too much.

Our report on
Instagram Usage Insights
led the sub-company’s CEO Kevin Systrom to confirm the upcoming feature, saying “It’s true . . .We’re building tools that will help the IG community know more about the time they spend on Instagram – any time should be positive and intentional . . .Understanding how time online impacts people is important, and it’s the responsibility of all companies to be honest about this. We want to be part of the solution. I take that responsibility seriously.”

Facebook has already made changes to its News Feed algorithm designed to reduce the presence of low-quality but eye-catching viral videos. That led to Facebook’s first-ever usage decline in North America in Q4 2017, with a loss of 700,000 daily active users in the region. Zuckerberg said on an earnings call that this change “reduced time spent onFacebookby roughly 50 million hours every day.”

Zuckerberg has been adamant that all time spent on Facebook isn’t bad. Instead, as we argued in our piece
“The difference between good and bad Facebooking,”
its asocial, zombie-like passive browsing and video watching that’s harmful to people’s wellbeing, while active sharing, commenting and chatting can make users feel more connected and supported.

Released today, America’s Most Endangered Rivers® of 2018 spotlights the battery of threats from the Trump administration and its allies in Congress to clean water and rivers nationwide. Take action today on behalf of this year’s endangered rivers.

Is your favorite river endangered? Check out the list below of the 2018
America’s Most Endangered Rivers®.

On this year’s list, zombie projects abound. From draining critical wetlands on Mississippi’s Big Sunflower River to mining in Minnesota’s Boundary Waters and the rivers of Alaska’s Bristol Bay, to building a border wall on the Lower Rio Grande,
America’s Most Endangered Rivers
® of 2018
illustrates the recurring attacks by the Trump administration and Congress on clean water, people and wildlife.

This is the kind of destruction that will be difficult and, in some cases, impossible to reverse. If the Trump administration and its supporters in Congress succeed in rolling back bedrock environmental protections and handing over our rivers to polluters, the health, well-being and natural heritage of our nation’s families and communities will be impoverished for generations to come.

The following rivers on this year’s list will be directly impacted by decisions from the Trump administration and Congress:

“Healthy rivers are essential to public health, our economy, and the well-being of our nation. We must insist that those tasked with managing our water resources have the best interests of the public in mind. America’s Most Endangered Rivers of 2018 highlights critical upcoming decisions and paints a stark picture of what’s at stake. It’s an important call to action that we must amplify nationwide,” said Jo-Ellen Darcy, former Assistant Secretary of the Army (Civil Works) and American Rivers board member.

On the #1 river on this year’s list, the Big Sunflower in Mississippi, members of Congress are pushing to undermine the
Clean Water Act
to resurrect the Yazoo Pumps, one of the most environmentally damaging projects ever proposed by the U.S. Army Corps of Engineers. If allowed to advance, it would be the first time ever that an EPA veto of a Corps project (the George W. Bush EPA stopped the project in 2008) was overturned by Congress, undermining the authority of the EPA to enforce the Clean Water Act.

The Yazoo Pumps Project would damage more than 200,000 acres of wetlands in the
Big Sunflower River
watershed in the heart of the Mississippi River Flyway. More than 450 species of fish and wildlife, including the Louisiana black bear, rely on the wetlands habitat that would be drained by the project.

The
Lower Rio Grande
, #4 on this year’s list, is threatened by border wall construction that would cut the Rio Grande off from its floodplain, potentially exacerbating flooding and erosion and blocking access to this life-giving resource for people and wildlife.